MyMedi-AI

V2521 — Contact lens, hydrophilic, toric, or prism ballast, per lens

HCPCS Level II V-code · short descriptor: “Cntct lens hydrophilic toric”

Code system
HCPCS Level II
Family
V — Vision & hearing services
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Prosthetics & orthotics
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

V2521 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $214.82 to $435.59 depending on state and rural status.

Former-CBA payment limits: ceiling $296.38 · floor $222.28

StateNon-ruralRural
AK$214.82—
AL$222.28—
AR$236.36—
AZ$222.28—
CA$222.28—
CO$247.23—
CT$230.86—
DC$262.20—
DE$262.20—
FL$222.28—
GA$222.28—
HI$229.73—
IA$263.64—
ID$222.28—
IL$296.38—
IN$296.38—
KS$263.64—
KY$222.28—
LA$236.36—
MA$230.86—
MD$262.20—
ME$230.86—
MI$296.38—
MN$296.38—
MO$263.64—
MS$222.28—
MT$247.23—
NC$222.28—
ND$247.23—
NE$263.64—
NH$230.86—
NJ$296.38—
NM$236.36—
NV$222.28—
NY$296.38—
OH$296.38—
OK$236.36—
OR$222.28—
PA$262.20—
PR$435.59—
RI$230.86—
SC$222.28—
SD$247.23—
TN$222.28—
TX$236.36—
UT$247.23—
VA$262.20—
VI$296.38—
VT$230.86—
WA$222.28—
WI$296.38—
WV$262.20—
WY$247.23—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps V2521 at 2 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related V-codes

Bill V2521 with confidence

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